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Homeostasis, Stress, Fluid & Electrolyte Balance, Shock

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Presentation on theme: "Homeostasis, Stress, Fluid & Electrolyte Balance, Shock"— Presentation transcript:

1 Homeostasis, Stress, Fluid & Electrolyte Balance, Shock
NURS 2016 Chapters 6, 14, 15

2 Homeostasis Homeostasis: processes that occur quickly in response to stress – adjustments made rapidly to maintain internal environment. Adaptation: processes resulting in structural or functional changes over time. This is a desired goal. Coping: a compensatory mechanism so that a person can reach equilibrium.

3 Stress A state produced by change in the environment that is threatening or damaging

4 Responses to Stress Psychological: appraisal – coping Physiological:
Alarm, resistance, exhaustion Maladaptive: Faulty appraisal Ineffective coping

5 The S&S of Stress Write down at least 10 Paste in table from page 87

6 Nursing Care Intervene when individual’s own compensatory processes are still functioning. Relate S&S of distress to physiological happenings. Identify person’s position on a continuum of function from wellness/compensation to pathophysiology/disease.

7 Stress at the Cellular Level
Individual cells may cease to function without posing threat to the organism; however as the number of dead cells increases, the specialized function of the tissue is altered – health is threatened.

8 Nursing Care Assess S&S for indicators of physiologic processes.
Relate symptoms/complaints to physical signs. Assist individual to respond to stress with stress management.

9 Fluid Volume Deficit (FVD) Hypovolemia
Weight loss Restlessness Dry mucous membranes Increased respirations Decreased urine output Thirst Flushed skin Poor skin turgor Systolic drop 10-15mmHg Sunken eyes

10 Nursing Care Monitor I&O Daily weight (1kg = 1000ml fld) Vital signs
Skin turgor- consider age Moisture level Lung sounds Urine concentration

11 Preventing and Correcting FVD
Who’s at risk? Replacement Oral Enteral Parenteral

12 Fluid Volume Excess (FVE) Hypervolemia
Weight gain Edema Abnormal lung sounds Increased urine output Puffy eyelids Distended neck veins Tachycardia Increased BP and pulse pressure.

13 Nursing Care Monitor I & O Daily weight Assess lung sounds
Check edema: degree of pitting measure extremities.

14 Preventing and Correcting FVE
Promote rest: favours diuresis and increases circulation (lower) Na+ and fluid intake restrictions Monitor parenteral fluids Positioning

15 Edema Localized or generalized
Occurs when there is a change in capillary member ANASARCA: severe generalized edema ASCITES: edema in peritoneal cavity Dependent area: ankles, feet, sacrum, scrotum, periorbital regions Pulmonary edema: increased fluid in pulmonary interstitium and alveoli

16 Electrolytes Sodium Normal 135-145mmol/L Potassium Normal 3.5-5mmol/L
Calcium Normal mmol/L

17 Sodium: Hyponatremia At Risk Loss of Na Dilution of Na Nursing Care:
Monitor I&O Daily weight Encouraging foods high in Na (normal requirement 500mg) Fluid restriction:800ml/day Clinical Manifestations: Anorexia, muscle cramps, exhaustion. Poor skin turgor, dry mucosa/skin Confusion, headache Those at risk for hyponatremia are those losing sodium and those diluting their sodium – it’s all about concentration. Sodium can be lost through loss of GI fluids or diuretics. Water intoxication can result from inappropriate antidiuretic hormone. The signs and symptoms depend on the severity of hyponatremia and also the speed in which sodium concentration decreases. Nursing Care: Close monitoring of intake and ouptu is critical. In addition, daily weights are an accurate indicator of fluid retention or loss – normal variance day to day is less than 5%. If the low sodium is due to sodium loss rather than dilution – sodium can usually be replaced through regular diet with attention to mg na . If hyponatremia is due to dilution, then water restriction may be necessary. Restricting fluid intake is safer then administering sodium.

18 Sodium: Hypernatremia
At Risk Loss of water Gain of sodium Nursing Care I&O No added salt diet Monitor meds high in Na If IV hypotonic solution used -- want gradual decrease in serum Na 9prevent cerebral edema Clinical Manifestations Thirst, dry mouth Restlessness, disorientation Edema Increased BP

19 Potassium: Hypokalemia
Nursing Care ECG for flattened T-wave ID cause Diet – high K Teaching – use of diuretics, laxatives IV K replacement At Risk Vomiting/gastric suctioning Alcoholics/cirrhosis Anorexia nervosa Non-K sparing diuretics With IV potassiuim replacement – infusion must be slow – achieved through dilution and rate of 100ml or less – 40mEq/1000ml – burns at site. If output goes less than 20ml/hr for 2 hours infusion should be stopped Foods rich in potassium: Daily requirement 2000mg – baked potato with skin is 844mg – banana is 500mg Clinical Manifestations Muscle weakness, fatigue, anorexia, N&V, leg cramps, dysrrythmia

20 Potassium: Hyperkalemia
At Risk Kidney disease Addison’s disease Extreme tissue trauma K replacement Nursing Care Verify high serum levels Restrict K foods Teaching re K supplements Note: prolonged use of tournique when drawing blood can give false high potassium readings – therefore important to varify findings of high Keep in mind that 98% of K is ICF, and 2% in ECF Clinical Manifestation Ventricular dysrrhythmia, muscle weakness, peaked t-wavwes, respiratory paralysis

21 Calcium:Hypocalcemia
Nursing Care Seizure precautions Airway status Nutritional intake and supplements Limit alcohol and caffeine At Risk Renal failure Postmenopausal Low Vit D consumption Antacids, caffeine Hypoparathyroidism Calcium: adequate calcium absorption depends on availability of Vit D from diet or synthesis in skin (sunlight) Calcium requirements 800mg per day Milk 250ml is 300 mg ½ cup broccoli is 90mg Clinical manifestations Tetany, seizures, depression,impaired memory, confusion

22 Calcium: Hypercalcemia
Nursing care Increase activity Encourage fluids Encourage fluids Na – favour Ca excretion Safety/comfort At Risk Hyperparathyriodism Bone/mineral loss during inactivity Thiazide diuretics Clinical Manifestations Reduced neuromuscular activity, weakness, incoordination, anorexia, constipation

23 Respiratory Acidosis Individuals at risk Clinical Manifestations
Inadequate excretion of carbon dioxide Chronic emphysema, bronchitis Obstructive sleep apnea Obesity Clinical Manifestations Increased cerebrovascular flow (vasodilation) Increased pulse, respirations and BP Mental cloudiness, feelings of fullness in head

24 Respiratory Acidosis Nursing care Improve ventilation
Clear respiratory tract Ensure adequate hydration

25 Respiratory Alkalosis
Individuals at risk Hyperventilation Increased anxiety Hypoxemia Clinical Manifestations Lightheadedness, low concentration, numbness/tingling, tinnitus

26 Respiratory Alkalosis
Nursing Care Recycle carbon dioxide Treat underlying cause

27 Shock Physiological state in which there is inadequate blood flow to tissues and cells of body Cells try to produce energy anaerobically Leads to low energy yield and acidotic intracellular environment

28 Categories of Shock Hypovolemic Cardiogenic Circulatory/Distributory

29 Stages of Shock Compensatory Progressive Irreversible
While there are three categories of shock, there are three primary stages of shock which are common to all categories.

30 Compensatory Stage BP normal Vasoconstriction Fight or flight
Increased HR Increased contractility Blood shunted to heart and brain. During this stage the body is trying to right itself.

31 Nursing Care in Compensatory Stage
Close assessment and catch subtle changes before decrease in BP occurs Monitor tissue perfusion. Report deviations in hemodynamic status Reduce anxiety Promote safety Tissue perfusion: vital signs, level of consciousness, output Deviations in hemodynamic status – vital signs – suble changes in BP – decrease pulse pressure

32 Progressive Stage: Mechanism for regulating BP no longer compensates
Respiratory: shallow, rapid Cardiac: dysrrhythmia, ischemia, tachycardia Neurologic: decrease status Renal:failure Hepatic:decrease met. of meds and waste Hematologic:DIC Gastrointestinal: Ischemia, increase risk infection

33 Nursing Care in Progressive Stage
Usually care for in ICU (increased monitoring) Preventing complications Promote comfort and rest Support family members

34 Irreversible Stage Individual in not responding to treatment.
Renal and hepatic failure lead to release of necrotic tissue toxins

35 Nursing Care in Irreversible Stage
Similar to progressive stage Brief explanations to patient Supportive presence for patient and significant others. In collaboration with significant stakeholders, discuss end of life wishes/decisions.

36 Overall Management of Shock
Fluid replacement Crystalloids: electrolyte solution Colloids: plasma proteins Blood components

37 Risks of Fluid Replacement
Cardiovascular overload Pulmonary edema

38 Fluid Replacement: Nursing Care
Monitor I& O Mental status Skin perfusion Vital signs Lung sound

39 Overall Management of Shock
Vasoactive medication to improve hemodynamic stability. Myocardial contract Myocradial resistence vasoconstriction Nutritional support Meet needs of increased met. Often parenteral feeding

40 Emergency Shcok position

41 Hypovolemic Shock Decreased intravascular volume due to fluid loss
What is a primary example

42 Nursing Care in Hypovolemic Shock
Prevention Fluid and blood administration Monitor for cardiac overload and pulmonary edema Monitor vital signs I&O Temperature Lung sounds Cardiac rhythm and rate.

43 Cardiogenic Shock Heart’s ability to contract and pump is impaired
General management Correct cause Administer oxygen Control chest pain Monitor hemodynamic status

44 Nursing Care in Cardiogenic Shock
Prevention Monitor hemodynamic status Administer IV fluids and medications Promote safety and comfort

45 Distributive Shock Blood is abnormally placed in the vasculature
Septic - wide spread infection. Number one cause of death in ICU Neurogenic Anaphylactic

46 Nursing Care in Septic Shock
Hyperdynamic phase Hypodynamic phase ID site and source of infection Antipyretic if T >40 Monitor response to medications Comfort measures Oxygen needs

47 Nursing Care in Neurogenic Shock
Results from loss of sympathetic tone Spinal cord injury Spinal anesthesia Nervous system damage Preventative: elevate head 30 degrees Support CV and neuro functions Elastic stockings Elevate head of bed Check Homan’s sign Passive ROM

48 Nursing Care in Anaphylactic Shock
Systemic antigen-antibody reaction Prevention: assess for allergies and observe response to new medications/ blood administration Remove causative agent Support cardiac and pulmonary systems


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